{
"Npi": {
"NPI": "1356788368",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BENTLEYVILLE MEDICINE SHOPPE INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "808 MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BENTLEYVILLE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15314-1214",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "724-239-3600",
"MailingAddressFaxNumber": "724-239-3601",
"FirstLinePracticeLocationAddress": "808 MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BENTLEYVILLE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "15314-1214",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "724-239-3600",
"PracticeLocationAddressFaxNumber": "724-239-3601",
"EnumerationDate": "05/30/2013",
"LastUpdateDate": "03/17/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CRUMRINE",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "724-239-3600",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PP482389",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}